Cosmetic Dentistry 101 – Laboratory Technician

Cosmetic dentistry often requires a dental technician to fabricate the indirect restorations such as porcelain veneers, crowns, onlays and inlays. The dentist prepares the tooth and takes a mold which is then sent to the dental lab. From this point on it is up to the skill of the dental technician. They need to create a restoration that fits perfectly, is made out of the finest materials, and matches the existing teeth in the mouth – not a small task.

Above is just one of the articles that my dental technician wrote for a respected dental journal called QDT (Quintessence of Dental Technology) about cosmetic dentistry. Together I have written several articles for this invitation only journal with my technician.

Below is a list of essential elements to look for when considering cosmetic dentistry, as they relate to the dental laboratory:

1. Who is the dental technician that will fabricate the restorations? (Veneers, crowns, etc.) Specifically, what qualifications does this individual have? Ask for pictures of work completed by this technician. Many dental offices do not have a relation with the technician and send their indirect restorations (crowns, veneers, etc.) to a “lab” that has many technicians. You never know who will make your tooth. Can we say “assembly line”? The only reason for doing this is cost – there are absolutely no other benefits to a dental practice other than it being cheap. Cheap and top quality do not go together. You need to know who will make the dentistry that is going into your mouth, and you need to know that they are extremely good at what they do. Find the website for your laboratory and see for yourself what they advertise.
2. What materials are going to be used in your restoration? Gold – what type? Porcelain – what type? Yes, it makes a big difference. Nearly pure gold is still the longest lasting restoration we can place as dentists. Yes, it is not cosmetic, but it lasts and still has its uses. That being said, there are different levels of gold quality that dentists can select: High Noble, Noble, and Base Metal. The only metal I feel that should be used in the mouth is High Noble gold alloy. Everything else is a compromise (it has trace elements that you do not want in your mouth)- it is cheaper for the dentist. With regards to porcelain, there are too many different types to mention. Your technician needs to be familiar with each of them and be able to use the best material for your unique situation. Some porcelains are stronger than others, some are brighter, some fit better, etc.  If this restoration is going to last a very long time than it is important to use the best materials.
3. Excellent technicians cost more.You are not only paying for the materials used to make your tooth, but for the skill of the operator. Just like the skill of the dentist, experience matters. A plastic surgeon places better sutures than a general doctor. A highly trained cosmetic dentist is better at cosmetic dentistry than a general dentist, and a highly trained dental technician is obviously better than a regular “fresh” dental technician. Often I have patients come to me for second opinions while in treatment. If they want the other dentist to complete the work I supply them with the information about which technician to have the dentist send the tooth to for fabrication. To date none have actually sent work to these technicians because the fee is too high. As we all know, you get what you pay for. So, the other dentist has the tooth made at his/her regular laboratory and guess what – the patient has sensitivity, the bite is wrong, the tooth looks horrible, and we have to redo the whole thing in my office. This happens almost weekly. The moral of the story: Get it done right the first time!